The latest news, views and opportunities from EWM Towers
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Take a look at our latest newsletter to find out more about the amazingly adventurous Dr Andrew Peacock
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The view from WEM towers is a very exciting one and here’s why.
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EWM’s Wild Medicine Course Changed our Lives
We know that education opens doors and as the EWM crew are both interested and a bit nosey, we love to hear what our alumni get up to after attending our courses. Naturally then, we were delighted to hear from Ian P, who told us he and his wife loved the 2013 Wild Medicine course so much, they’re busy packing up in the UK and moving to Namibia…
Not many things you can say that change your life! Attending the Wild Medicine course was one of those events.
Amazing set of people and a fantastic opportunity to learn about conservation and desert medicine.
The kind of odd things we learnt…
– Take blood from a cheetah,
– Learn about (and touch – optional) many poisonous snakes,
– Sleep in a desert, walk 14km through a dry river canyon,
– What are the problem animals with Rabies? (A: Kudu),
– How can carnivores live outside conservation areas & not get killed by farmers &
villagers?
– How to build a vineyard in a desert … what?!..And the thing that changed our lives? Meet the Bushmen and see their need for healthcare! My wife and I are volunteering at Naankuse to run the Bushmen medical services. The real thing we learned? There are many people out there that can benefit from our skills …
Oh and by the way Namibia is amazing you get to see loads … but you can also get a 4×4 and do a week or so trip before the course.
Expedition Medicine’s UK Course welcomes their University Liaison
Dr Nick Knight - Expedition Medicine University Liaison (c) Mark Hannaford FRGS
Expedition Medicine’s UK Course Welcomes their University Liaison
With the sunshine out and the rasping sounds of the Search and Rescue Teams over the two-way radios out on the Cumbria hills – you would have been easily mistaken in thinking you were in the middle of a real emergency. In fact, it was the final Search and Rescue exercise (with CASEVAC) of a fantastic 4 day Expedition Medicine Course in Keswick in Cumbria.
As the University Liaison for Expedition Medicine, it was the first course that I attended as a new member of the ‘EM faculty’ – and what a fantastic experience it was. Not only did I get to absorb the electric atmosphere of the 60+ delegates there alongside the seasoned expedition medics leading the course but it gave me ample opportunity to see how such courses can align themselves with my role as University Liaison and to stimulate a few more ideas.
International 'World Extreme Medicine Conference & Expo' – London 2012
International Extreme Medicine EXPO- Expedition & Wilderness | Tactical | Disaster Medicine
‘Taking Medicine To The Extremes’
A major new International ‘World Extreme Medicine conference and EXPO’ series with the first inaugural event in London April 2012 followed by Salt Lake City in September 2012 with the very best speakers from around the world, leading figures from the world of expedition and wilderness travel, displays from focused industry leaders and also awards. All CME accredited on a modular basis to allow you select just a day or to attend the entire medical expo.
Over the last ten years the care of casualties in a remote environment has come a long way. This has been driven by conflict, the apparent exponential rise in natural disasters and our capacity to respond on an international scale and not least by the evolving interest in the field of expedition and wilderness medicine. The conference concept was generated out of a desire to amalgamate the associated specialties in this field and to share the skills and knowledge we have acquired. It will run over 4 days and involve some of the major specialists in their field of remote and austure medicine.
Developed specifically with medical professionals in mind the International ‘World Extreme Medicine EXPO’ will also be of interest to other medical specialists and students for which there will be a discounted rate.
To pre-register your interest for ‘Extreme Medicine’ email us here.
Extreme Medicine Conference and Expo
Treatment of Cholera in Active Malaria Zone
The treatment of cholera in an active malaria zone is a difficult matter. This is especially true with lessons being learned in Haiti and their recent cholera outbreak. I am specifically referring to the combination of Chloroquine (antimalarial) and the antibiotic class Macrolides (used in treatment of cholera). A post that I made back in 2009 has new recent relevance and I wanted to repost that here:
Azithromycin, Chloroquine and Arrythmias:
Travel medicine frequently uses medicines that are taken under special circumstances and for short periods of time, like a trip. Many travelers carry an antidiarrheal antibiotic on their trip and a common choice is azithromycin. This can potentially be a problem when they are also traveling in a malaria area and using chloroquine for prevention. Two very commonly used medicines chloroquine (antimalarial) and azithromycin(macrolide antibiotic used for respiratory infections and diarrhea) both have wonderful safety profiles, individually. However when taken together, there is discussion of the chance of a heart arrhythmia, specifically prolonging the QT interval. In fact, my software I use for prescribing cites this as a combination to avoid.
There are several important articles that can be used to look at this problem and evaluate the risks. One very good paper looks at medications that prolong this QT interval:
- “What clinicians should know about the QT Interval” by Sana M. Al-Khatib, et al.
These authors list azithromycin as a “very improbable” medication, although other macrolides are listed as higher risk. Chloroquine is listed as an “Unknown” medication, with respect to prolongation of QT interval. This article was based on expert opinions.
- “Azithromycin/Chloroquine combination does not increase cardiac instability despite an increase in monophasic action potential duration in the anesthesized guinea pig” by Fossa, et al.
This study looked directly at this problem, in animal models. Their research showed no increase in arrhythmia risk.
- “Lack of a pharmacokinetic interaction between azithromycin and chloroquine” by Cook, et al.
A wonderful article that is actually helping to look at using this drug combination to treat resistant forms of malaria. More about this combination and treating malaria here. Their study did show an increase in the QT interval in both groups of those who received chloroquine alone and those who received the combination of chloroquine and azithromycin. This QT interval increase was maximum on day number three and returned to baseline by the end of the study.
Most of the information I am finding looks reassuring for safely using this combination, in healthy individuals. Those with a history of arrhythmia should use this combination with caution and discuss this problem with their doctor, before they take these two medicines within a close amount of time.
Contributer: Dr Erik McLaughlin | www.adventuredoc.net
Pre-hospital Expedition Medicine Series – Pelvic Injury
Pre-hospital Expedition Medicine Series
Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar and HEMS paramedic Dave Marshall, both part of the Kent Helicopter Emergency Medical Team, continue their series examining pre-hospital expedition trauma care and associated kit.
In the second article in the series, Dave Marshall gives an overview of managing pelvic fractures pre-hospitally and in an expedition environment, and introduces the use of the pelvic splint.
Edited by Dr Amy Hughes.
Pre hospital and Expedition management of pelvic trauma and use of the pelvic splint
Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential. Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Pelvic Sam Splint is essential.
Mechanism of Injury
Pelvic fractures often result in extensive disruption of the bony structures and associated ligaments of the pelvis and are potentially life-threatening injuries. The fractures associated with the greatest morbidity and mortality involve significant forces such as motor vehicle crashes, motorcyclist crash, pedestrian versus car, falls from height and crush injuries. Early suspicion, identification and management of a pelvic fracture at the prehospital stage is essential to reduce the risk of death as a result of hypovolaemia, (1). It is especially important to be able to identify, treat and minimize risk of further damage when in a remote area miles from the nearest medical facility.
Understanding the mechanism of injury is vital in being able to predict the potential for significant injury to the pelvis and its underlying structures, even in the absence of clinical signs. It is, therefore, essential that time is taken to evaluate the mechanisms involved in any accident resulting from significant force or where there is pain or injury to the spine, abdomen, pelvis or femurs.
In motor vehicle accidents – a not uncommon event on expeditions – learning how to ‘read’ the wreckage to help identify possible pelvic injury, in conjunction with clinical suspicion, can significantly aid diagnoses.
The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis.
The intrusion into fuel tank shows the imprint of the riders pelvis. This would often result in significant fracture to the pelvis – often multiple, often ‘’open book’’ pelvis.
Anatomical structure of the pelvis
The pelvic ring is often likened to a polo mint in that it is almost impossible to have a significant break in one place and not another. The most common area to be damaged in trauma is the pubic rami, acetabulum and the sacroiliac joint. There is extensive vasculature through and around the pelvic ring, most notably the iliac vessels. For imagery see > http://visualsunlimited.photoshelter.com/image/I0000kUOn3NJHcZU.
The greatest risk of a pelvic fracture is catastrophic haemorrhage and gentle handling of the patient in the initial and subsequent stages could literally be the difference between life and death. Whole blood clotting time is approximately 10 minutes, (depending on the environment). Expedition medics should be familiar with the ‘first clot best clot’ theory. In other words, a patient sustaining a traumatic injury resulting in haemorrhage will begin to form a clot using their own clotting factors. If this clot is disrupted they could easily bleed to death. A full fluid resuscitation will not be practical in the field as most expeditions carry a maximum of 2 litres of crystaloid. However it should be noted that overloading the patient with fluid can be equally harmful, and small boluses should be given to maintain a central pulse and cerebral perfusion. This is known as permissive hypotension and will be discussed in more detail in a future article. Disruption of this first clot in the prehospital setting could be fatal, and without access to blood and clotting agents the patient may die. Trauma will result in the patient becoming acidotic, hypothermic, and coagulopathic. (3)
This coagulopathy cannot be easily reversed pre-hospitally, each factor contributes to the decline in the others. (see above diagram). Any disruption to the first clot will have devastating consequences. Ultimately, the patient requires definitive haemorrhage control, (surgery, angiography and embolisation), and replacement of blood and clotting agents.
The glass pelvis: Think of the pelvis as being made of very fragile glass, and you can see the clot in the form of a cartoon jelly inside. The jelly is very delicate and unless movement is gentle and kept to a minimum, it will ‘wobble’ to the point of destruction very easily. The same applies to the blood clot! Early recognition of the potential for a pelvic injury, gentle handling and prompt stabilisation is vital to improve the outcome of a patient injured on an expedition.
Clinical Features of a pelvic injury:
- Management of pelvic fractures and clot preservation:
Asymmetry of the pelvis – do not spring the pelvis. Visual alignment and gentle palpation of the Anterior Superior Iliac Spine may help demonstrate pelvic injury, but often the pelvis visually appears normal, thus mechanism of injury is vital in determining injury - Shortening/rotation of the leg/s
- Inguinal pain
- Localised swelling/contusion
- Hematuria/urinary incontinence
- Bleeding PR/PV – PR examination not recommended to determine pelvic injury.
- MECHANISM, MECHANISM, MECHANISM! (albeit not a clinical feature!) – there may be no obvious clinical abnormality despite significant injury. Thus clinical suspicion is essential.
As we have already discussed, a patient with a suspected pelvic fracture must be handled very carefully. Whether in a medical facility or the most extreme expedition environment, the same principles apply to prevent worsening the injury and preserving the clot.
Log rolling the patient should be avoided at all costs!
The medical kit available on expeditions will be minimal. Stretchers may have to be improvised and transportation limited. However, all medical kits should have some sort of pelvic binder which should be applied carefully and correctly at the earliest opportunity,
Application of the pelvic SAM splint.
The casualty will inevitably have to be placed in the supine position, to evacuate them on whichever device is available. This can be achieved by a coordinated team approach utilising other members of the expedition.
One person should be at the head end of the patient maintaining in manual inline immobilisation, (MILS), and they will give clear commands to the team when moving the casualty, (“ready, brace, roll”). A pelvic binder such as the one shown can be applied using a minimal 10-15% roll, (enough to get a bum cheek off the ground!)
Once in position the device can be tightened just enough to maintain anatomical alignment. Do not over tighten as this could cause significant further damage!
Log rolling patients.
Whilst sometimes useful in a controlled hospital environment following appropriate imaging, should be avoided in the pre hospital field. In simple risk versus benefit terms it could have catastrophic consequences. By using the hands available and correctly briefing the team about the amount of movement required (one cheek off!), it should be possible to optimise the care of the casualty prior to evacuating them to definitive care.
Improvised methods of pelvic splinting on expeditions
Much of the challenge of expedition medicine is improvisation. The medical kit you take out with you may not have SAM splints in them. Providing a support can be placed across the greater trochanter, then any sort of material could be used – for example clothing, a sheet, or a canvass of some kind.
Fluids
The approach to fluid management in trauma has changed. Two litres of fluid is not necessarily required for management of pelvic injury. Titrate fluid according to the presence of pulses or cerebration (alertness). The presence of a radial pulse, and even in certain circumstances (without associated head injury) presence of a femoral pulse signifies the blood pressure is sufficient to perfuse the necessary organs and promote clot preservation. Further details of permissive hypotension will follow in another article.
Analgesia
Essential – this depends on what is available. Intravenous opiates or a fentanyl lolly is ideal for analgesia, after the use of paracetamol or a NSAID.
Other injuries
Pelvic injuries are often present in conjunction with other significant injuries – spinal, femur, urological or abdominal as examples. Whether or not other injuries have been excluded, spinal precautions are essential in conjunction with good management of the pelvis.
References
- Lee C, Porter K. The prehospital management of pelvic fractures, Emergency Medical Journal 2007;24:130-133
- Maya A, Matinowitz U, Kluger Y. Coagulopathy in the critically injured patient, Yearbook of Intensive Care and Emergency Medicine 2006, Part 5,232-243
- Crawford C, Pelvic Fracture in Emergency Medicine, available at: http://emedicine.medscape.com/article/825869-overview
Some feedback just makes us smile!
Feedback on our recent Polar Medicine training course in Norway has clearly affected some of the course delegates by creating a need for ‘biggles-speak’…
PapaFoxtrot calling Red Leaders AlphaHotel, AlphaCharlie, DeltaBravo, Bravo and Delta
Congrats on recent Operation Polar Bear
Wizard week
No prangs
Best ever
Location stunning
Bunks and chow excellent
Red Leaders all SPLENDID
Hope all returned to base safely
Please pass on to all members of Polar Bear as don’t have call signs
Do you read me ?
Over
Keele Medical School interviews Dr Amy Hughes, Medical Director at WEM
Dr Amy Hughes medical career has been far from ordinary and she talks about how she has ended up as medical lead at WEM.
Dr Hughes co-leads with Dr Luanne Freer our CME accredited Mountain Medicine course on the Everest Base Camp trail in Nepal.
Expedition Medicine’s University Liaison, Dr Nick Knight writes about his work with the Ocean Rowing Teams record Indian Ocean attempt
A team of four university friends from the South of England are attempting a record-breaking expedition across the Indian Ocean this summer. They are being supported on land by Expedition Medicine’s University Liaison, Dr Nick Knight who is their research coordinator, trainer and nutritionist.
The team is planning to row the 3100 miles from Australia to Mauritius in less than 68 days, 19 hours and 40 minutes – the fastest ever crossing time for a 4s boat.
Starting out in Geraldton, Western Australia the crossing will finish on the island of Mauritius and with only eleven boats having so far successfully completed the crossing, the adventure will be tough. The expedition will see the four man crew suffer extreme fatigue, mental stress and intense isolation. They risk crippling sores and the countless dangers involved in crossing a great Ocean in a small open craft. The adventurers will have minimal help from winds and currents, so will need to row in 2 hour shifts for 24 hours a day for almost ten weeks to complete their mission.
Acute mountain sickness – a review by Dr Sean Hudson
Management of AMS
Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT)
High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. The researchers sought to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.
Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).
Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).
Fascinatingly the authors demonstrated that Ibuprofen and acetazolamide are similarly effective in preventing HAH. This adds another medication to the useful arsenal to use in the treatment of AMS and in particular is especially useful when you have a patient who can’t take acetazolamide (diabetics or sulphur allergies) .
Learn more about Altitude Medicine by joining Expedition and Wilderness Medicine’s CME accredited Mountain Medicine course in Nepal headed up by Everest ER founder Dr Luanne Freer
Wilderness Medical Society approves Desert Medicine course in Namibia for 20.5 CME
Feedback from delegates in our unique Desert Medicine medical training course in Namibia is feedback enough but the Wilderness Medical Society has also awarded it 20.5 CME points.
‘I had a fantastic time and feel like I learnt a lot. I will definitely be signing up for more courses and recommending the courses to people I know!’ Desert course participant.
Developed for medical professionals or advanced medics working in hot or arid climates. The Desert Medicine Course aims to introduce participants to the skills required to be a valuable member of a desert expeditionary team, and to care for and treat injuries and illness likely to occur in this fascinating environment.
Our Desert Medicine Course is based in Damaraland, an area bounded to the south by the spectacular Namib Desert, to the east by the Kalahari, Ovamboland to the North and the world famous Skeleton Coast to the west. Located near the famous Doros Crater, a massive volcanic crater formed over 140 million years ago. Our training area is a stunning region, remote from civilisation, inhabited by an array of desert adapted flora and fauna and with some of the most remarkable night skies in the world. As a result of the recent changes in wildlife management in Namibia, the Doros Crater has been chosen as the region in which the endangered white rhinos are being released. It is a very exciting location inhabited by elephants, hyena, giraffe, rhinos, cheetahs and occasionally lions. It is almost unique in Namibia and for this reason we have endeavoured and been allowed to gain access to this virtually uninhabited area. Its the perfect location for our desert course.
Nick Arding OBE joins as part of the Nepal Mountain Medicine Team
Nick Arding will be joining Expedition Medicines Mountain Medicine course on the Everest Base Camp Trail along with Dr’s Luanne Freer of Everest ER and Amy Hughes of Kent HEM’s service in October on what promises to be an amazing CME accredited course*.
Nick served as an officer in the Royal Marines for 22 years, travelling and climbing widely during that time. In ‘92 he took part in the British Annapurna 2 Expedition and in ‘93 led his own trip to climb the West Buttress of Mt McKinley in Alaska. He commanded the Commando Training Centre Royal Marines from 2003 to 2005.
In 2003 Nick led a Royal Navy expedition to climb Everest by its North Ridge; not only did they climb the mountain but his team were instrumental in rescuing two other climbers from above 8000m, the highest mountain rescue on record and for which he was awarded the Royal Humane Society Bronze Medal.
A keen rock climber and mountaineer since his teens, Nick holds the Mountaineering Instructor (MI) and International Mountain Leader (MIA) awards.He left the Royal Marines in 2005 to qualify as a teacher and now works as a leadership coach and management consultant. He has led civilian teams to Mongolia, Nepal and the Alps, and when not working can usually be found on a rock face or in a sea kayak! In 2009 Nick took a team of friends to the Rolwaling Valley in Nepal to attempt an unclimbed mountain called Cheki-go. He has close links with this region, having raised funds to sponsor local Sherpas, three of whom have been able to visit the UK to improve their climbing skills and English language.
*accredited by the Wilderness Medical Society
Dr Amy Hughes featured
Expedition Medicine’s Medical Director Dr Amy Hughes describes her role of the Kent Air Ambulance HEMS doctor to ‘She’ magazine in their December issue
Dr Amy Hughes is currently a specialist registrar in pre-hospital care working for the Helicopter Emergency Medical Team (HEMS) in Kent. She has been involved in expedition medicine for the last 7 years, providing medical cover for all extremes of environments, including developing and leading the medical cover for a desert ultra marathon. She is involved extensively in teaching of expedition medicine and recently took over as medical director of Expedition Medicine. Amy completed the Diploma of Tropical Medicine in 2006, has a European Masters in Disaster Medicine and is en route to gaining a Post Graduate Certificate in Aeromedical Retreival.
To read more follow this link Dr Amy Hughes Expedition Medicine PDF
Great week on Keswick Expedition Medicine course
Another superb Expedition and Wilderness Medicine training course in Keswick
The Great North Air Ambulance, dedicated to Expedition Medicine facualty member Dr Rupert Bennett sadly killed in a climbing accident on Ben Nevis, lands as part of a search and rescue training scenerio on the course which aims to prepared medics for working in remote locations and is accredited by the Wilderness Medical Society.
Expedition Medicine are delighted to announce the launch of a brand new medical malpractice insurance facility
Specifically aimed at Tour Medics and medical professionals accompanying groups/tours outside of the UK.
This product has been developed in conjunction with specialist industry brokers, Campbell Irvine and is open to all UK-resident medically-qualified professionals.
It is designed to work alongside your current UK medical malpractice cover and is competitively priced to reflect this.
Cover provides worldwide territorial limits and has a worldwide excluding North America legal jurisdiction as standard. Cover will not operate for UK risks, as these will be covered by your existing policy. The policy is underwritten by recognised Medical Malpractice Insurers.
Quotations are very quick and easy to obtain. Further information and application forms are available from Alan Pattison at Campbell Irvine on 020 7937 6981 or [email protected]
Campbell Irvine (Insurance Brokers) Limited are authorised and regulated by the Financial Services Authority
Hannah McKeand has kindly agreed to be the guest speaker on the September Keswick Expedition Medicine Course
Guest speaker – Hannah McKeand, renown Polar Explorer
In 2004 Hannah joined a British expedition to explore the isolated Wakan Corridor in the northeast of Afghanistan in search of the source of the River Oxus. The strip is walled by the Hindu Kush in Pakistan to the south, the Pamirs in Tajikistan to the north and the Karakorams in China to the east. The upper regions of this mountain valley can only be reached on foot by crossing several 15,000ft passes and has rarely been visited by westerners. Part of the research was to take DNA samples of the nomadic tribe people there to establish their genetic links to Alexander the Great and his army.
Later that year Hannah turned to a cold desert in an epic 56 day expedition skiing the 730 miles and 10 degrees from the coast of Antarctica to the geographic South Pole. Crossing the vast and monotonous expanse of one of the harshest environments in the world the team of five battled with physical and mental exhaustion, frostbite, injury, hunger and some of the lowest temperatures on earth.Far from taking it easy after her Antarctic adventure, in September 2005 Hannah set sail from Liverpool as a Watchleader aboard Glasgow Clipper in the Clipper Round the World Yacht Race. She raced with the fleet from Liverpool to Cascais in Portugal, Salvador in Brazil, Durban, Fremantle and Singapore. Half way through the next leg to China the boats were diverted to The Philippines with major keel issues and the race was delayed for two months for a rebuild.
While the boats were being rebuilt Hannah and her partner David Pryce returned to his home in Australia and bought the 20m aluminium expedition schooner The Blizzard.
They formed their high latitude sailing company Blizzard Expeditions and eventually did not return to the Clipper Race. In November/December 2006 Hannah returned to Antarctica and once again skied from Hercules Inlet to the South Pole, but this time solo and unsupported. She set a new world record for the journey of 39 days 9 hours and 33 minutes. In October 2007 Hannah and David embarked on their first full season with The Blizzard sailing from Australia across to Chile and from there around Cape Horn and down to Antarctica, then back to Australia via the Falklands, The Kergulens and the South Magnetic Pole, thus completing a full circumnavigation of Antarctica in a season.
In February 2008 Hannah set out solo from Ward Hunt Island in the North of Canada in a first attempt at soloing to the North Pole. Just over two weeks in she had a dramatic fall into the ice and seriously injured her shoulder and back and was forced to retire. She is now once again fully fit and in training for her next attempt.
It rained in the desert!
The 2010 Desert Course
Our foreign courses always run on a fairly fluid timetable, but this year’s Desert Course in Namibia was certainly more fluid than expected. Having never seen rain in the desert before, we had rain every day bar one, most of it torrential. A storm on the second night tried its hardest to blow down/away most of the tents and the large tarps put up by Faan, our local agent. His cooking staff had never experienced such a storm and then still managed to produce a hot meal for us all shortly afterwards.
We still had a great week. The group included some extremely experienced medics and everybody contributed to the learning. A fascinating demonstration of snake handling from Stuart involved his venomous and non-venomous snakes and a parabusis scorpion.
We trekked in some seriously hot conditions and at times were lucky with cloud cover. One unexpected bonus was coming across a deep pool of water in a bend on a (usually permanently dry) riverbed giving us the chance to swim in the desert – magical. The view from the high peak of the Doros Crater Rim was well worth the walk in. Out final night out was luckily under the beautiful Southern Cross and the other stars as the clouds finally relented. We walked past fresh rhino tracks and saw herds of zebra, springbok and flighty ostriches as we drove out. Faan looked after us impeccably as usual.
Mother Nature surprised us again at the end of the course when the volcanic ash prevented Mark and I, and many of the course participants from flying home at our intended times. The latest person home was 10 days late and one participant endured an epic 3 day flight/train/train/ferry/train/ferry/train journey. At least we are all getting used to the unexpected.
Caroline Knox
Piers Carter writes about the UK course in March
Expedition Medicine March 10 UK course
Our flagship course in Keswick went well this month. We had 60 participants who experienced the full range of Lakeland weather during their time in Keswick.
Once again, Barrow House YHA hosted our course with excellent food, service and an amazing location. Whilst the programme remains broadly the same we invite new evening lecturers in and we vary the faculty. Nigel Harling did a fine job of the communications lecture and we welcomed back Dr Lesley Thomson for the diving lecture.
Our days are always a combination of indoor sessions, which include lectures, small group discussions or work groups and outdoor simulations or practical sessions. On day-1 the afternoon was a round robin of 4 mini-teaching sessions including RTC management, fracture immobilisation; wound management and managing altitude sickness. Ben Cooper ran the wound management and has developed the session into an interactive and engaging session where there are plenty of photos and bits of kit to get hands on. This went down well with all involved.
Participants were pleased to hear from Carolyn Henry from Raleigh who came up for an evening and told us about her experiences and how she had gone from being a delegate on one of our courses years ago to be Raleigh’s medical coordinator. Many of us at Expedition Medicine have history with Raleigh and we still see them as a great place to begin ones expedition career.
The highlight of day-2 is the safety on steep ground afternoon; students learn how to coil ropes, set up safe anchor points and lower colleagues off steep cliffs and drops. Also covered is the reality of improvising a carrying mechanism for various injuries.
Nigel Harling from BSES, British Schools Exploring Society, came in to explain how willing medics can travel with them and he then went on to entertain the audience with his tales of daring do and high adventure from his past and present expeditioning days. It was a memorable evening lecture and one we shall, no doubt, ask him to do again.
Day-3 has a very specific environments feel covering hot, cold, tropical, altitude and diving medicine and then closed with an excellent talk Sarah Outen. Last year Sarah rowed solo across the Indian Ocean and she told us of close encounters with whales, albatross, shops and freak storms which threatened to ‘munch her in their fangs!’ It was an inspirational talk and we wish Sarah luck on her next adventure where she intends to circumnavigate the globe by Sarah power.
The final day scenario saw the successful rescue of 6 casualties from various locations on the hill side and the arrival of the Mountain Rescue Landrover, the crew demonstrated how they would package up a casualty in one of their onboard stretchers for transportation to hospital. This looked like a somewhat more comfortable option than the rope stretchers our willing participants constructed to collect and transport their casualties.
All casualties and participants safely back to the hostel in fine weather and the final session discussed next steps and further opportunities. We staff thoroughly enjoyed ourselves and we hope the participants did too. Until next time we wish all Expedition and Wilderness Medicine graduates all the very best and we look forward to seeing you on future courses.
Piers Carter
Expedition and Wilderness Medicine